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In this course, learners will become familiar with principles and theories of global health problems, and major challenges and controversies in improving global population health as well as practical applications of quantitative methods to analyze and interpret issues and challenges for policy. Topics will include health and foreign policy, health governance, acute disease surveillance, non-communicable diseases, burden of disease, universal health coverage, health systems strengthening, health financing, and human resources for health and ageing.

From the lesson

Global Health Policy and Governance

There are four modules in this lecture series. We will start with key issues in current global health policy and governance. The year 2015 reminded political leaders and the public that people’s safety is a genuine challenge at a time of disease epidemics, terrorism, refugee and migration crises, and climate change among others. The recent Ebola virus outbreaks in west Africa exposed weaknesses in core global functions, such as the provision of global public goods, management of cross-boarder externalities and fostering of leadership and stewardship. This module describes major challenges and issues in global health policy and proposes actions in global health, in particular for Japan at the G7 Ise-Shima Summit.

Meet the Instructors

Hiroshi Nishiura

Professor, Graduate School of Medicine, Hokkaido University(Former Affiliation) Associate Professor, Graduate School of Medicine, The University of Tokyo

Stuart Gilmour

Professor, Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University(Former Affiliation) Associate Professor, Graduate School of Medicine, The University of Tokyo

Kenji Shibuya

Professor and ChairDepartment of Global Health Policy, Graduate School of Medicine

So we discussed about epidemical [INAUDIBLE],

including rising of non-communicable disease and also disease.

So that means, in terms of priorities in global health policy,

it's really tricky because we still have unfinished agenda of communicable disease,

as described in the MDGs, and we see the non-communicable disease epidemic.

And finally, all of these confounded with inevitable consequences

of globalization, such as climate change, trade policy,

intellectual property rights and human rights issues.

In terms of who are the major players in global health, it's proliferating.

Starting from national government, we have the UN, and development banks,

and public variety of partnerships, such as GAVI alliance, or Global Fund.

And we see a growing contribution of private philanthropies, such as Bill and

Melinda Gates Foundation, or Rockefeller Foundation.

And obviously, civil society, NGO's, and

we shouldn't forget about the contribution from private industries and

professional association or academies like us.

So there's large numbers present in global health.

That leads to, kind of fragmented lack of coordinated and

concentrated effort at the country level, as you can see from this figure.

It will present the proliferation of partnerships.

What are the major governance challenges for global health?

First, there is a classic tension between national sovereignty and

the imperative of international collective action.

There's a clashed tension between collective action and country sovereignty.

And second is legitimacy and accountability.

For example,

in the case of private philanthropies who are they held accountable?

That is a very fundamental question.

And finally, cross-sector interdependence.

So there is an interaction between health and education, health and

national security, health and trade or environmental issues.

So all of these are making the global health governance

more complicated than before.

In terms of resources available in global health,

this is the figure of development assistance for health from 1990 to 2014,

analyzed by the Institute of Health Metrics and Evaluation.

Since 1990, US$458 million of development assistance has been

provided to maintain or improve health in developing countries.

And the recent studies show that substantial rise in diseases for

global health until 2009, the length of increase has stagnated in these two years.

The effects of funds was accompanied by major changes in the institutional

landscape of global health.

With global health initiatives such as the Global Fund and the GAVI alliance

having a center row in mobilizing and channeling global health funds.

And the proportion of development assistance for

health channel through the UN, and

development banks decreased from 1990 to 2014.

But the Global Fund, GAVI alliance, non-government organization became

the major trader for an increasing share of development assistance for health.

And the largest source of funding was always the United States which provided

over US$140 billion between 1990 and 2014 including

12.4 billion in 2014.

And the second largest source of development assistance of health was

private philanthropic donors including the Bill and

Melinda Gates Foundation and other private foundations.

Those private philanthropic donors provided

nearly US$17 billion between 1990 and

2014 including 6.2 billion in 2014.

And this slide shows the flow of finance in global health in 2014.

Since 1990, 28% of all development assistance of health was allocated for

maternal health, and newborn and child health.

And 23.2% for HIV AIDS and nearly 4% for

malaria and 3% for tuberculosis, and

1.5% for non-communicable disease.

And between 2000 and 2010, development assistance for

health increased 11% annually.

But since 2010,

total development assistance of health has not increased substantially.

Funding for health in developing countries has increased substantially since

1990 with a focus on, again HIV/AIDS, maternal health and new born child health.

And funding from the US government has played

a substantial role in this expansion.

Funding for

new coming disease has been very limited despite of fact we see a large share

of disease burden due to non-communicable disease in developing countries.

Understanding how funding patterns have changed across time and

the priorities of sources of international funding across distant channels, donors,

and health workers may help identify where funding gap exist.

The other aspect of [INAUDIBLE] in these ideas is

adoption of new global development goals,

that is SDGs, Sustainable Development Goals.

In September 2015, the United Nations general assembly adopted

the 2013 agenda for sustainable development and

sustainable development goals which emphasize the first university.

And second sustainability, not just property elaboration.

And finally, they emphasize close sector growth partnership particularly

between government and civil society.

And has primary driven by technocrats but

SDGs is really comprehensive cooperative process.

MDG house was a very prominent goals,

six goals out of total eight was [INAUDIBLE] health.

The SDG out of total 17 goals has its one of it.

But the scope has changed, has expanded, from communicable disease and

health to include aging and non-communicable disease.

Therefore the focus of global health policy has expanded beyond these specific

programs to embrace health systems and universal health coverage.

To summarize this session,

there is a changing context in global health these days.

We saw a lot of epidemiological transition in developing countries, and

it impact globalization.

And obviously, there is a growing sense of inequities.

And we see new political and economic powers in developing countries.

And rather than multi-lateral cooperation we see multi-polar geopolitics on going.

We cannot ignore the market forces and

impact on commercialization in health care.

As we see the trend of development assistance for

health, we see a stagnant ODA share.

And we see competing agenda not just health but

also climate change, refugees, migration issues or [INAUDIBLE].

So, global health is really at the.

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